Satellite Request Form

Satellite Downlink Service Request
840 Wood Street (G-37 Becker Hall), Clarion, PA 16214
Telephone: (814) 393-1644 or Fax: (814) 393-2065

Please provide all required information and submit the form to request satellite downlink services.

Name:

Telephone:

Today’s Date:

Campus Address:

Department:

Name of satellite broadcast program:

Date of broadcast:

Start time:

End time:

Please verify: Start and end broadcast times are for the Eastern Time Zone. Yes:

Is a signal test broadcast scheduled? Yes: No:

Time of test broadcast:

Do you wish to have this program recorded on video tape? Yes: No:

If yes, please initial here to verify you have copyright permission to record this program:

Do you wish to view this program ‘live’? Yes: No: (if yes, reserve room through the Events and Scheduling office)

Assigned site:

Number of attendees expected:

Have you arranged for refreshments though the University's Food Service? Yes: No:

Please note: Food and beverages are not permitted in Clarion classrooms

Technical Information:

Satellite Name:

C Band:

Ku Band:

Transponder #:

Channel #:

Polarity:

Broadcast Frequency:

MHz Audio:

Originating Site:

Backup Satellite Name:

C Band:

Ku Band:

Transponder #:

Channel #:

Polarity:

Broadcast Frequency:

MHz Audio:

Broadcast telephone help number:

Signature:

Your signature is not required if submitting this form via e-mail. Include your signature only if you fax this form to Learning Support Services.

E-Mail:

If you are submitting this form via the submit button or e-mail you must include your email. Confirmations will be sent to that address.

LSS USE ONLY: Job Number ____________